Perceived Control Important in Treating Pain, Depression in Older Patients

Treatment of older people with depression and pain should be multifactorial, including a psychological component with a focus on perceived control.

Perceived control plays an important role in the association between pain and the presence of depression in older people suggesting that clinicians need to focus on treating both a patient’s pain and psychological conditions together, according to research published in the Journal of Affective Disorders.

Dr Margot W.M. de Waal, PhD, and co-authors from the Netherlands found that there is an indirect effect through perceived control on the chance of having a depressive disorder. For each 10-point increase in the pain intensity score, the chance of having a depressive disorder was 1.24 higher as a consequence of changes in perceived control. In older patients with depression, however, the role of perceived control as mediator was much smaller.

Pain and depression in older people have co-occurrence rates of 30% to 50%, the authors wrote. Pain can hinder recovery from depression, while depression can mask the diagnosis of pain and related disabilities. The current research adds to growing evidence that psychological factors play an important role as mediator between depression and pain, the authors wrote. Previous research showed that higher self-efficacy for managing pain was associated with less pain-related disability and less depression in those with chronic pain.

“Our results underline that treatment of older people with depression and pain should be multifactorial, including a psychological component with a focus on perceived control,” Dr de Waal, a senior researcher at Leiden University Medical Center in Leiden, Netherlands, told Clinical Pain Advisor. “Clinicians should be aware of this when evaluating treatment opportunities. Especially at old age, pharmacological treatment of pain is challenging, and older persons might prefer psychological treatment and support in self-management.”